Unvaccinated children should be excluded during measles outbreaks

Unvaccinated children who may have come into contact with an infected person should be excluded from school until measles outbreaks are over, say public health experts.

The report from local health boards and Public Health Wales says ‘assertive efforts’ should be made to target teenagers for MMR vaccination in the wake of the recent measles outbreak centred on Swansea.

It says that immunisation sessions should take place within two days of a case of measles and that unimmunised ‘close contacts’ should be excluded from school until the infectious period is over.

The report from local health boards and Public Health Wales details how the outbreak unfolded between November 2012 and July 2013.

It warns that, while 30,000 people between the ages of 10 and 18 remain unvaccinated in Wales, there is still the chance of further outbreaks and calls for ‘aggressive control of measles cases imported into or transmitted within Wales’.

A total of 1,202 cases of measles were reported in the outbreak. Of these, 88 people were admitted to hospital and one 25 year old man died.

The report praises the work of GP surgeries during the outbreak: ‘Primary care proactively encouraged parents to take incompletely immunised children to their local GP surgeries, the numbers attending rose dramatically with 7,714 non-routine doses of MMR administered by GPs in the week ending 15 April 2013.’

In total, it says, more than 70,000 doses of MMR were given throughout Wales by August 2013. However, it says uptake in the group hardest hit by the outbreak – children and young people aged 10 to 18 – was “disappointing”. Of an estimated 50,887 children in this age group requiring vaccination, only 21,493 came forward for vaccination.

But it adds that more drastic measures should be considered in the event of future outbreaks: ‘The exclusion of unimmunised close contacts of probable cases of measles from school, child care and other child centred social settings until the infectious period is over. Where necessary this should be backed by a formal request to co-operate under public health law if necessary.’

The report also recommends:

As a priority, health boards should continue to develop and implement plans to improve MMR coverage rates in children and young adults. This planning should include looking at novel settings (such as sexual health clinics) for delivering MMR to older teenagers/young adults.

Electronic linkage to the Child Health System of records of vaccines given by GPs. GP practices and Public Health Wales health protection teams should be provided with read-only access to child health records held by the Health Boards.

In outbreaks where interventions are targeted at teenagers, assertive efforts should be made to target this age group directly, maximising opportunities afforded by social media and other channels of communication. However, targeted communication should be backed up by easy access to MMR jabs; likely to involve outreach clinics where young people congregate.

Dr Marion Lyons, director of health protection for Public Health Wales, said: ‘The only guarantee against catching measles is receiving the full two doses of the MMR vaccine, and while we have 30,000 children and young people still needing vaccination, we can’t assume we will not see further outbreaks of this scale.

‘With 88 people being admitted to hospital and one dying during this outbreak, it’s clear that measles is a serious illness and no parent or young person should believe it cannot happen to them.’

Dr Sara Hayes, director of public health for ABMU Health Board, said: ‘I urge the young people who did not take the vaccine to contact their doctor. It’s never too late and the outbreak has proved just how safe and effective it is. We are currently responding to a further outbreak of measles in the Neath area with 36 cases to date. This shows that, despite the large outbreak being over, measles is still a very real problem in Wales.’